Do I need an in-person exam for Topamax in California?

If you’re struggling with binge eating disorder (BED), you might wonder whether you can access treatment from the comfort of your home. The short answer is yes—telehealth has made it easier than ever to connect with qualified healthcare providers who can diagnose BED and prescribe medications like Topamax (topiramate) or Wellbutrin (bupropion) without requiring you to visit a clinic in person.

This guide will walk you through everything you need to know about getting BED treatment via telehealth in 2026, including which medications are available, what the laws allow, and how to ensure you’re receiving safe, high-quality care.

Understanding Binge Eating Disorder and Treatment Options

Binge Eating Disorder is the most common eating disorder in the United States, affecting millions of people. It’s characterized by recurrent episodes of eating large quantities of food in a short period, feeling out of control during these episodes, and experiencing distress afterward—without the compensatory behaviors (like purging) seen in bulimia.

According to DSM-5 criteria, BED involves eating an unusually large amount within a two-hour period at least once weekly for three months, accompanied by feelings of loss of control and marked distress. Treatment typically combines psychotherapy, nutritional counseling, and in some cases, medication.

While Vyvanse (lisdexamfetamine) is the only FDA-approved medication specifically for BED, it’s a controlled substance with stricter prescribing requirements. Many healthcare providers use off-label medications like topiramate (Topamax) or bupropion (Wellbutrin) that have shown effectiveness in reducing binge episodes and are easier to prescribe via telehealth.

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Federal Telehealth Rules: What You Need to Know in 2026

Non-Controlled Medications Are Fully Accessible

Here’s the important news: medications like Topamax and Wellbutrin are not controlled substances, which means they’re not subject to the strict federal telehealth restrictions that apply to medications like stimulants or opioids.

The Ryan Haight Act, which normally requires an in-person medical evaluation before prescribing controlled substances via telehealth, simply doesn’t apply to non-controlled medications. This means healthcare providers can legally prescribe topiramate or bupropion after a thorough telehealth evaluation—no in-person visit required.

Current DEA Extensions Through 2026

While federal rules around controlled substances continue to evolve, the DEA has extended COVID-era telehealth flexibilities through December 31, 2026. This extension primarily affects controlled medications, but it reflects the federal government’s broader commitment to maintaining telehealth access for patients nationwide.

For your BED treatment with non-controlled medications, these rules provide stability and assurance that telehealth prescribing will remain accessible throughout 2026 and beyond.

State-by-State Telehealth Rules: Where You Can Get Treatment

While federal law allows telehealth prescribing of non-controlled medications, individual states have their own additional requirements. The good news? Most states have embraced telehealth permanently, with few requiring periodic in-person visits.

States With No In-Person Requirements

The majority of states—including California, New York, Texas, Florida, Delaware, Michigan, Wisconsin, and South Carolina—allow healthcare providers to prescribe non-controlled BED medications entirely via telehealth, with no mandatory in-person visits.

California has been particularly progressive, with legislation (AB 1503) that explicitly allows ‘good faith exams’ to be conducted via asynchronous telehealth (like online questionnaires) when appropriate. This means you could potentially complete your entire evaluation online without even a video visit, though most providers still prefer real-time video consultations for initial assessments.

New York updated its regulations in May 2025 to require in-person exams for new controlled substance prescriptions, but this rule specifically exempts non-controlled medications. You can receive Topamax or Wellbutrin via telehealth in New York without any in-person requirement.

States With Periodic Follow-Up Requirements

A handful of states ask for periodic in-person follow-ups for ongoing telehealth care:

Alabama requires that if you have more than four telehealth visits for the same condition within 12 months, you must see a provider in person within that year. However, this in-person visit can be with any collaborating provider—it doesn’t have to be your telehealth prescriber.

Georgia requires an annual in-person exam attempt for continued telemedicine care, though the initial evaluation can be done entirely via telehealth if the technology used meets the standard of care.

New Hampshire recently updated its laws (effective August 2025) to allow even controlled substances to be prescribed via telehealth initially, with an in-person follow-up required within 12 months. For non-controlled BED medications, this represents minimal restriction.

These periodic requirements are designed to ensure continuity of care rather than create barriers to initial treatment access.

Who Can Prescribe BED Medications via Telehealth?

Physicians, Nurse Practitioners, and Physician Assistants

In all 50 states, licensed physicians (MDs and DOs) can prescribe topiramate and bupropion via telehealth. But you may also see Nurse Practitioners (NPs) or Physician Assistants (PAs), and their prescribing authority varies by state.

As of 2025, 34 states plus Washington D.C. now grant Nurse Practitioners full practice authority, meaning they can evaluate patients and prescribe medications independently without physician oversight. This list recently expanded to include Wisconsin and Michigan, both of which passed legislation in 2023-2025 modernizing APRN practice.

In states with full practice authority—like California, New York, New Hampshire, Delaware, and Michigan—an NP working for a telehealth platform can provide your complete BED care independently, from diagnosis through ongoing medication management.

In other states, NPs and PAs work under collaborative agreements with physicians. This is common in states like Texas, Florida, Georgia, and Alabama. The collaboration requirement happens behind the scenes and typically doesn’t affect your patient experience—you’ll still receive care primarily from the NP or PA, with physician oversight ensuring quality.

Klarity Health’s Provider Network

At Klarity Health, we connect patients with licensed healthcare providers—including psychiatrists, psychiatric nurse practitioners, and physician assistants—who are experienced in treating eating disorders and mental health conditions. Our providers are licensed in your state and follow all applicable state and federal telehealth regulations.

Because we accept both insurance and offer transparent cash-pay pricing, Klarity makes BED treatment accessible regardless of your coverage situation. Our providers are typically available for appointments within days, not weeks, which means you can start your recovery journey quickly.

Topamax (Topiramate) for Binge Eating Disorder

How It Works

Topiramate is an anticonvulsant medication originally approved for seizure disorders and migraine prevention. While not FDA-approved specifically for BED, multiple clinical studies have shown it can reduce binge frequency and support weight management in people with binge eating disorder.

The medication appears to work by affecting neurotransmitters in the brain that regulate impulse control and appetite. Many patients report decreased food cravings and a reduced urge to binge when taking topiramate.

Dosing and Titration

Topiramate is typically started at a low dose (25mg) and gradually increased over several weeks to minimize side effects. The effective dose for BED usually ranges from 75mg to 200mg daily, though some patients respond to lower doses.

Because the medication requires careful titration, your telehealth provider will schedule regular follow-ups during the first few weeks to monitor your response and adjust the dose as needed.

Important Safety Considerations

Pregnancy Risk: Topiramate carries significant risks during pregnancy, including increased risk of cleft palate and other birth defects. If you’re pregnant, planning pregnancy, or could become pregnant, discuss effective contraception with your provider before starting this medication. Topiramate is generally not recommended during pregnancy.

Cognitive Effects: Some people experience ‘brain fog,’ word-finding difficulties, or concentration problems on topiramate. These effects are usually dose-related and may improve with dosage adjustment.

Kidney Stones: Staying well-hydrated is important while taking topiramate to reduce the risk of kidney stones.

Discontinuation: Never stop topiramate suddenly, as this could trigger seizures even in people without epilepsy. Your provider will create a gradual tapering schedule if you decide to discontinue.

Your telehealth provider can prescribe up to a 90-day supply with refills, making ongoing treatment convenient once you’re stabilized on the medication.

Wellbutrin (Bupropion) for Binge Eating Disorder

How It Works

Bupropion is an antidepressant that’s FDA-approved for depression and smoking cessation. It works differently from other antidepressants by affecting dopamine and norepinephrine—neurotransmitters involved in reward, motivation, and impulse control.

Research suggests bupropion can help reduce binge eating episodes in some patients, particularly those who also experience depression or who struggle with emotional eating patterns.

Dosing and Formulations

Bupropion comes in immediate-release, sustained-release (SR), and extended-release (XL) formulations. For BED, providers typically prescribe the XL version taken once daily, starting at 150mg and potentially increasing to 300mg or 450mg depending on response.

The extended-release formulation provides steady medication levels throughout the day, which may help with consistent appetite regulation.

Critical Safety Information

Seizure Risk: This is the most important safety concern with bupropion. The medication lowers seizure threshold, and the risk increases with higher doses and in certain populations.

Contraindication in Eating Disorders with Purging: Here’s something crucial—bupropion is contraindicated (should not be used) in people with current or recent bulimia or anorexia nervosa. The seizure risk is significantly elevated in these conditions. Your telehealth provider will carefully screen to ensure you have BED without purging behaviors before prescribing bupropion.

No Alcohol: Avoid alcohol while taking bupropion, as it further increases seizure risk.

Suicidal Thoughts Warning: Like all antidepressants, bupropion carries a black box warning about increased risk of suicidal thoughts, particularly in people under 25. Your provider will monitor your mood closely, especially when starting treatment or adjusting doses.

Blood Pressure: Bupropion can raise blood pressure in some people, so monitoring is important, especially if you have hypertension.

Despite these precautions, bupropion is safely used by millions of people. The key is proper screening and ongoing monitoring—exactly what responsible telehealth providers offer.

The Telehealth Evaluation Process: What to Expect

Initial Assessment

When you schedule a telehealth appointment for BED treatment, expect a comprehensive evaluation that typically lasts 30-60 minutes. This is not a quick ‘prescription mill’ visit—legitimate providers conduct thorough assessments that mirror in-person care.

Your provider will ask detailed questions about:

• Eating patterns: Frequency and nature of binge episodes, amounts consumed, feelings of control
• Medical history: Other health conditions, current medications, allergies
• Mental health: Depression, anxiety, trauma, other psychiatric conditions
• Previous treatments: What you’ve tried before and how it worked
• Family history: Eating disorders, mental health conditions, substance use
• Lifestyle factors: Exercise, sleep, stress levels, social support

Many providers use standardized questionnaires like the Eating Disorder Examination Questionnaire (EDE-Q) or Binge Eating Scale (BES) to help establish the diagnosis and measure severity.

Identity and Location Verification

Don’t be surprised when your provider asks you to verify your identity and location. This isn’t about mistrust—it’s a legal requirement in many states to ensure the provider is licensed in your state and to prevent fraud.

You may be asked to show your ID and confirm your physical address at the start of the visit. This protects both you and the provider by ensuring the telehealth encounter meets all regulatory requirements.

Informed Consent

Before prescribing, your provider will explain:

• How the medication works for BED (off-label use)
• Potential benefits and realistic expectations
• Side effects and risks
• Alternatives to medication (therapy, nutritional counseling)
• What telehealth can and cannot do

You’ll sign a telehealth consent form acknowledging this information. Take time to read it and ask questions—this is your healthcare, and you deserve to understand it fully.

Prescription Monitoring and Safety Checks

Although Topamax and Wellbutrin aren’t controlled substances requiring mandatory Prescription Drug Monitoring Program (PDMP) checks in most states, many providers still review your medication history as a safety precaution.

This helps identify:

• Potential drug interactions
• Duplicate prescriptions you might not have mentioned
• Medications that could increase seizure risk with bupropion
• Overall medication safety profile

Your provider may also recommend baseline lab work—like a comprehensive metabolic panel, liver function tests, or pregnancy test—before starting medication. While not always required, these tests provide important safety information.

Who Should NOT Pursue Telehealth BED Treatment

While telehealth greatly expands access to care, it’s not appropriate for everyone. Responsible providers will screen for conditions that require in-person evaluation or rule out certain medications:

Medical Red Flags

Active purging behaviors: If you’re experiencing bulimia (binge eating with purging) rather than BED, bupropion is contraindicated due to seizure risk. You may need specialized eating disorder treatment.

Seizure disorders: Uncontrolled epilepsy or history of seizures makes both topiramate and bupropion riskier. In-person neurological evaluation may be needed.

Pregnancy or breastfeeding: Topiramate carries significant pregnancy risks. If you’re pregnant, trying to conceive, or breastfeeding, discuss this immediately with your provider.

Severe medical instability: If your binge eating has resulted in urgent medical complications—diabetic emergencies, severe electrolyte imbalances, cardiac issues—you need immediate in-person medical care.

Suicidal ideation: While depression can be treated via telehealth, active suicidal thoughts with intent or plan requires immediate crisis intervention, not a scheduled telehealth appointment.

When You Need a Higher Level of Care

Telehealth works well for mild to moderate BED in medically stable individuals. However, severe cases may require:

• Intensive outpatient programs (IOP)
• Partial hospitalization programs (PHP)
• Residential eating disorder treatment
• In-person multidisciplinary teams

If your provider determines your needs exceed what telehealth can safely provide, they should refer you to appropriate resources rather than attempting inadequate remote treatment.

Understanding Off-Label Prescribing for BED

You might wonder why your provider is prescribing medications ‘off-label’ for BED when they’re approved for other conditions. This is actually very common in medicine and completely legal.

Off-label prescribing means using an FDA-approved medication for a condition other than what it was originally approved to treat. Doctors do this when research supports the medication’s effectiveness for the off-label use.

For BED specifically:

• Research studies have demonstrated topiramate’s effectiveness in reducing binge frequency and supporting weight loss
• Clinical trials have shown bupropion can help some patients with binge eating, particularly those with co-occurring depression
• Medical guidelines from psychiatric and eating disorder organizations acknowledge these medications as treatment options

Your provider should:

• Explain that the medication is being used off-label
• Discuss the research supporting this use
• Present alternatives (including therapy-only approaches)
• Document your informed consent

Off-label use is standard practice and, when done thoughtfully with patient consent, represents good medical care tailored to individual needs.

Red Flags: How to Spot Questionable Telehealth Services

The telehealth boom has brought tremendous benefits, but it’s also attracted some bad actors. Here’s how to distinguish legitimate services from concerning ones:

Warning Signs

Prescription guaranteed before evaluation: No responsible provider can promise a prescription without first evaluating you. If a service advertises ‘guaranteed prescriptions,’ that’s a red flag.

Superficial assessments: A legitimate BED evaluation takes time. If you’re offered a prescription after a 5-minute chat or just a questionnaire, the service isn’t meeting the standard of care.

No discussion of alternatives: Medication is just one tool for BED. Providers should at least mention psychotherapy, nutritional counseling, or other approaches. If they only push pills, be skeptical.

Pressure tactics: High-pressure sales language (‘Sign up now! Limited spots!’) is marketing, not healthcare. Good providers want informed patients, not rushed decisions.

Direct medication sales: Legitimate telehealth providers send prescriptions to regular pharmacies (retail or mail-order). If the service wants to sell you medication directly from their own supply, that’s highly irregular for prescription medications.

No licensed provider information: You should know your provider’s name, credentials, and license number. If this information is hidden or vague, that’s concerning.

Too-good-to-be-true pricing: While affordable care exists, pricing that seems impossibly low may indicate corner-cutting on quality, unlicensed providers, or other problems.

What Legitimate Services Look Like

Transparent pricing: Clear information about costs, with options for both insurance billing and cash payment.

Licensed, credentialed providers: Names, credentials, and state license numbers publicly available.

Comprehensive evaluations: Initial visits of 30+ minutes with detailed history-taking.

Informed consent processes: Clear explanations of risks, benefits, and alternatives.

Follow-up care plans: Scheduled monitoring visits, not just one-and-done prescriptions.

Pharmacy integration: Prescriptions sent electronically to your choice of licensed pharmacy.

Privacy compliance: HIPAA-compliant platforms and clear privacy policies.

Emergency protocols: Clear instructions for what to do if you have a crisis or urgent medical issue.

Klarity Health exemplifies these best practices with transparent pricing, experienced licensed providers, thorough evaluations, and coordinated pharmacy services—all while offering quick appointment availability.

Insurance Coverage and Costs

Insurance Coverage for Telehealth

Most health insurance plans now cover telehealth visits at the same rate as in-person visits, a change that became permanent in many states during the COVID-19 pandemic.

Your coverage typically includes:

• Initial psychiatric evaluation
• Follow-up medication management visits
• Mental health therapy sessions (if you combine medication with therapy)

Check your specific plan for:

• Copay amounts for psychiatry or mental health visits
• Whether your telehealth provider is in-network
• Any prior authorization requirements

Cash-Pay Options

If you don’t have insurance or prefer not to use it, Klarity Health offers transparent cash-pay pricing. This can be advantageous because:

• No surprise bills or insurance denial issues
• Your visit remains completely private (not reported to insurance)
• Often faster appointment availability
• Predictable, upfront costs

Medication costs vary by pharmacy and insurance coverage. Both topiramate and bupropion are available as inexpensive generics—often $10-30 per month without insurance using discount programs like GoodRx.

Comparing Costs: Telehealth vs. Traditional Care

The convenience and time savings of telehealth often translate to real cost savings beyond just the appointment fees.

What Happens After Your Prescription: Follow-Up Care

Getting a prescription is just the beginning of your BED treatment journey. Effective care requires ongoing monitoring and support.

Typical Follow-Up Schedule

Week 2-4: First follow-up to assess how you’re tolerating the medication, review any side effects, and evaluate early response. Dose adjustments often happen at this visit.

Months 2-3: Monthly check-ins to monitor progress, adjust dosing, and address any concerns.

Long-term: Once stabilized, visits may spread to every 2-3 months for ongoing medication management.

Some states require periodic in-person visits (as noted earlier for Alabama, Georgia, and New Hampshire), but these can usually be satisfied with any local provider, not necessarily your telehealth prescriber.

What Your Provider Will Monitor

• Binge episode frequency: Are you having fewer binges?
• Severity: Are episodes less intense when they occur?
• Weight changes: Many patients see weight stabilization or loss
• Side effects: Managing any unwanted effects
• Mental health: Mood, anxiety, overall functioning
• Medication adherence: Taking medication as prescribed

Combining Medication with Therapy

While medication can help reduce binge urges and frequency, the most effective BED treatment typically combines medication with psychotherapy. Evidence-based therapies include:

Cognitive Behavioral Therapy (CBT): Helps identify and change thoughts and behaviors that trigger binges

Dialectical Behavior Therapy (DBT): Teaches emotion regulation skills and distress tolerance

Interpersonal Therapy (IPT): Addresses relationship patterns that may contribute to binge eating

Many telehealth platforms, including Klarity Health, can connect you with licensed therapists who specialize in eating disorders, allowing you to receive both medication management and therapy conveniently online.

Privacy and Security in Telehealth

Your medical information is protected by HIPAA (Health Insurance Portability and Accountability Act) whether care is delivered in-person or via telehealth.

Legitimate telehealth platforms use:

• Encrypted video connections: Your visit is secure and private
• Secure messaging: Communications with your provider are protected
• HIPAA-compliant record systems: Your health information is stored securely
• Limited data sharing: Your information is only shared as you authorize or as required by law

What Gets Shared and What Doesn’t

Your provider WILL share information:

• With pharmacies (to fill your prescription)
• With your insurance company (if you use insurance for payment)
• If there’s an imminent safety threat to you or others (legal duty to warn)
• If subpoenaed by a court (rare)

Your provider WILL NOT share information:

• With family members without your written consent
• With employers or schools without your permission
• For marketing purposes
• With non-medical staff beyond what’s necessary for care

You have the right to access your medical records and to know who has accessed them.

Recent Regulatory Updates (2025-2026)

The telehealth landscape continues to evolve. Here are the most recent developments affecting BED treatment access:

Federal Updates

DEA Extension (January 2026): The DEA extended COVID-era telehealth prescribing flexibilities for controlled substances through December 31, 2026. While this primarily affects controlled medications (not your BED medications), it signals continued federal support for telehealth access.

Medicare Coverage: Medicare extended telehealth coverage for mental health services through 2026, with strong bipartisan support suggesting permanent extension is likely.

State Legislative Changes

New Hampshire (August 2025): SB 252 explicitly allowed telehealth prescribing of Schedule II-IV controlled substances with annual in-person follow-up, modernizing the state’s telehealth laws to match federal flexibilities.

New York (May 2025): Adopted regulations requiring in-person exams for new controlled substance prescriptions once federal waivers end, but specifically exempted non-controlled medications. This clarified that telehealth for medications like Topamax and Wellbutrin remains fully accessible.

Wisconsin (2025): The APRN Modernization Act granted nurse practitioners independent practice authority, expanding the provider pool for telehealth mental health services.

Michigan (2025): Public Act 47 of 2023 took full effect, establishing full practice authority for nurse practitioners and enhancing telehealth access statewide.

Delaware (July 2025): SB 101 clarified that telemedicine is permitted for medication-assisted treatment for opioid use disorder, resolving previous conflicts and affirming the state’s commitment to telehealth access for addiction and mental health treatment.

What These Changes Mean for You

The regulatory trend is clearly toward expanding and stabilizing telehealth access, not restricting it. While some states are adding guardrails for controlled substance prescribing (appropriately, given abuse concerns), access to non-controlled medications for conditions like BED remains strong and is actually improving in many states.

As of 2026, you can be confident that telehealth for BED treatment is not a temporary pandemic measure—it’s become a permanent, regulated part of the healthcare landscape.

Frequently Asked Questions

Can I use telehealth for BED treatment if I live in a rural area?

Absolutely. Telehealth is particularly valuable for rural residents who may not have easy access to specialized eating disorder treatment. As long as your provider is licensed in your state, you can receive care from anywhere with internet access.

Do I need special equipment for telehealth visits?

No. A smartphone, tablet, or computer with a camera, microphone, and internet connection is all you need. Most telehealth platforms work through your web browser or a simple app download.

What if I don’t have insurance?

Many telehealth providers, including Klarity Health, offer transparent cash-pay options. The medications themselves (topiramate and bupropion) are inexpensive generics, making treatment affordable even without insurance.

Can my regular doctor prescribe these medications instead of using telehealth?

Certainly. If you have a primary care provider or psychiatrist you’re comfortable with, they can prescribe these medications for BED. Telehealth is simply an additional option that offers convenience and quick access to specialists.

How long will I need to take medication for BED?

This varies by individual. Some people benefit from several months of medication while developing healthier eating patterns through therapy, then taper off. Others find longer-term treatment helpful. Your provider will work with you to determine the right duration based on your response and goals.

What happens if I have side effects?

Contact your provider right away. Many side effects are manageable with dose adjustments or timing changes. Your provider can also switch you to a different medication if needed. Between scheduled visits, most telehealth platforms offer messaging or nurse lines for questions.

Can I switch from in-person to telehealth care or vice versa?

Yes. Many people start with telehealth for convenience, then transition to in-person care if they prefer, or vice versa. Your treatment records can be transferred between providers with your consent.

Taking the Next Step: Getting Started with Telehealth BED Treatment

If you’re ready to explore telehealth treatment for Binge Eating Disorder, here’s what to do:

1. Research telehealth providers in your state. Look for platforms with licensed providers, transparent pricing, good reviews, and comprehensive care approaches. Klarity Health offers experienced mental health providers with availability within days, accepts both insurance and cash payment, and provides transparent pricing upfront.

2. Gather your medical information, including current medications, known allergies, previous treatments you’ve tried, and any relevant medical history. This will help your provider conduct a thorough evaluation.

3. Schedule an initial evaluation. Most platforms allow you to book online and offer appointments within days rather than the weeks-long waits common for in-person psychiatry.

4. Prepare for your visit by thinking about your eating patterns, what triggers your binges, your treatment goals, and questions you want to ask. Write them down so you don’t forget during the appointment.

5. Be honest and thorough during your evaluation. Your provider can only help based on the information you provide. Don’t minimize symptoms or hide relevant history out of embarrassment—eating disorders are medical conditions, not character flaws.

6. Follow through with the treatment plan, including taking medication as prescribed, attending follow-up visits, and considering therapy if recommended.

7. Be patient with the process. Medication effects build over time, and finding the right dose may take several weeks. BED recovery is a journey, not an overnight fix.

Conclusion: Telehealth Makes BED Treatment More Accessible Than Ever

Binge Eating Disorder is a serious but treatable condition. For too long, access to specialized care has been limited by geography, provider shortages, and long wait times. Telehealth has fundamentally changed this landscape.

In 2026, the regulatory framework supporting telehealth is stronger and more stable than ever. Non-controlled medications like Topamax and Wellbutrin can be prescribed via telehealth in all 50 states, with minimal barriers in most locations. The expansion of nurse practitioner practice authority in many states has increased the provider pool, and federal extensions of telehealth flexibilities signal long-term commitment to this care model.

Whether you choose Klarity Health or another reputable telehealth provider, you can access evidence-based BED treatment quickly, affordably, and conveniently—without sacrificing quality or safety.

The most important step is the one you take today: reaching out for help. Binge Eating Disorder doesn’t have to control your life. With the right support, you can develop a healthier relationship with food and find freedom from the shame and distress of binge eating.

Ready to start your journey? Klarity Health’s licensed providers are available for appointments within days and can work with you to develop a personalized treatment plan. Visit our website to learn more about our transparent pricing, provider credentials, and how we can help you access the care you deserve.

Research Currency Statement

Verified as of: January 4, 2026

DEA Rules Status: COVID-19 telehealth prescribing flexibilities remain in effect through December 31, 2026 (fourth extension). No federal in-person requirement exists for non-controlled medications—these were never subject to the Ryan Haight Act restrictions on telemedicine.

States Verified: Researched 10+ key states (AL, CA, DE, FL, GA, NH, NY, TX, MI, WI, SC) with latest information as of late 2025. State board sites and 2025 legislative updates were checked where available.

Sources newer than 2024: 80%+ of sources are from 2025 (many late-2025) or updated to 2025. Older sources (2024) were used only when confirmed still accurate by newer references.

Flagged for follow-up: Alabama and South Carolina NP scope changes (legislation was discussed in 2025 but final status unclear—assume no full independence yet pending confirmation). Monitor DEA’s pending final rule on telehealth prescribing (expected by end of 2026). Verify any temporary state waivers for expiration/extension beyond 2025.

Citations

1. U.S. Department of Health and Human Services. (2026, January). DEA extends telemedicine prescribing waivers through December 31, 2026. Retrieved from https://www.hhs.gov/press-room/dea-telemedicine-extension-2026.html

2. Sheppard Mullin Richter & Hampton LLP. (2025, August). Telehealth and in-person visits: Tracking federal and state updates to pandemic-era telehealth exceptions. Retrieved from https://www.sheppardhealthlaw.com/2025/08/articles/telehealth/telehealth-and-in-person-visits-tracking-federal-and-state-updates-to-pandemic-era-telehealth-exceptions/

3. Center for Connected Health Policy. (2025, November-December). State telehealth laws and reimbursement policies: Online prescribing database. Retrieved from https://www.cchpca.org/topic/online-prescribing/

4. Health Jobs Nationwide. (2025). State-by-state guide: Expanding roles for PAs and NPs (Updated 2025). Retrieved from https://blog.healthjobsnationwide.com/state-by-state-guide-expanding-roles-for-pas-and-nps-updated-2025/

5. The National Law Review. (2025, May). Telehealth and in-person visits: Tracking federal and state updates to pandemic-era telehealth exceptions. Retrieved from https://natlawreview.com/article/telehealth-and-person-visits-tracking-federal-and-state-updates-pandemic-era

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